Apidra®: A New Rapid Acting Insulin

Contributed by: Jeffrey A. Burnes, Pharm.D. Candidate

UMKC School of Pharmacy

Text Box: Glulisine (Apidra®) is a rapid acting human insulin analog that is produced by utilizing recombinant DNA technology. This technology utilizes a non-pathogenic laboratory strain of E. coli. The amino acid sequence is different for glulisine than other human insulin such as Humalog® and Novolog® in that asparagine has been replaced by lysine at position B3 and lysine has been replaced by glutamic acid at position B29. Glulisine is a clear, colorless, and sterile solution. Glulisine’s primary mechanism of action is to lower blood glucose levels. Blood glucose levels are reduced by stimulating peripheral glucose uptake by skeletal muscle and fat and through the inhibition of hepatic glucose production. Glulisine is indicated for the treatment of adult patients with Type I or Type II diabetes. Since glulisine has a more rapid onset of action and a shorter duration than regular insulin, it should be used in regimens that include long-acting or basal insulin. The dosing of glulisine should be individualized to the patients needs and based on the recommendations of a physician. One unit has the same glucose reducing effect as one unit of Novolog® or Humalog®. Glulisine should be administered via subcutaneous injection in the abdominal wall, thigh or the deltoid muscle or the subcutaneous tissues. As with the other insulins, injections sites should be rotated

Text Box: from one site to the next. Glulisine should be administered 15 minutes before a meal or 20 minutes after starting a meal. If glulisine is mixed with NPH insulin, glulisine should be drawn into the syringe first. Adverse effects of Glulisine include hypoglycemia, fatigue, mental confusion, headache, edema, pain or warmth at site of injection, muscle weakness and blurred vision. Glulisine is contraindicated during episodes of hypoglycemia and in patients who are hypersensitive to glulisine or one of its excipients. Gluisine is available in a 3 ml cartridge system and each package contains 5, 3 ml cartridges. These cartridges are specific for the Opticlik insulin delivery device. Once a cartridge has been inserted into the Opticlik pen it does not require refrigeration and can be stored a room temperature just as long as the temperature does not exceed 77° F (25° C) for 28 days. Glulisine should not be stored in a freezer. Glulisine also comes in a 10 ml vial, which contains 100 units per ml. As with the cartridges opened vials must be discarded after 28 days. These vials can be kept unrefrigerated for up to 28 days and they should be stored out of direct heat and light. All unopened vials or cartridges should be stored in a refrigerator and can be stored until their labeled expiration date. As with other insulin, glulisine’s glucose lowering potential can be reduced by corticosteriods, diuret

Text Box: ics, albuterol, oral contraceptives, protease inhibitors and atypical antipsychotics such as olanzapine or clozapine. Other substances can increase glulisine glucose lowering potential and increase a patient’s susceptibility to hypoglycemia. These substances include oral antidiabetic medications, ACE inhibitors, Prozac®, Fibrates, and sulfonamide antibiotics. Apidra® gives diabetic patients another option for a short acting insulin which has faster onset of action and with less chance of hypoglycemic events than Novolog® or Humalog®. For more Information please go to www.apidra.com or talk with your pharmacist or physician.